Town of Lyons EcoPass Application Form

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PRIMARY APPLICANT INFORMATION

Please note that you need copies of you need digital copies of photo ID(s), proof of Lyons residence and head shot for each applicant to complete this application.

First Name*

Surname*

Phone Number*

Email Address*

Date of Birth*

Date of Birth

Address*

City*

State*

Zip Code*

Select The appropriate category for the primary applicant*

Regular Pass

Senior age (65+)

K-12 student (6-16)

Individual with disability

Note: Children ages 5 and younger ride free with a fare-paying adult.

Upload Head-shot

Take a photo of the primary applicants head and shoulders and upload it here. Please take the photo against a white backdrop and remove any hats or sunglasses. If you cannot do this feel free to come by Town Hall and we can take a photo of you.

Upload Copy of ID

Scan or take a photo of your ID and upload it here. If you cannot do this feel free to come by Town Hall and we will make a paper copy for you.

Upload Proof of Address

Scan or take a photo of a a document that has your physical address on it and upload it here. If you cannot do this feel free to come by Town Hall and we will make a paper copy for you.

ADDITIONAL APPLICANTS (Family Members in the Same Household)

If more than two additional applicants please complete the two below and then start a new form with additional applicant information. If you are only applying for yourself please scroll down to the submit button below.

First Name (Additional Applicant 1)

Surname (Additional Applicant 1)

Date of Birth (Additional Applicant 1)

Date of Birth (Additional Applicant 1)

Select Category (Additional Applicant 1)

Regular Pass

Senior Age (65+)

K-12 student (6-16)

Individual with disability

Upload Copy of ID (Additional Applicant 1)

Scan or take a photo of your ID (if over 18) and upload it here. If you cannot do this feel free to come by Town Hall and we will make a paper copy for you.

Upload Head-shot (Additional Applicant 2)

Take a photo of additional applicants head and shoulders and upload it here. Please take the photo against a white backdrop and remove any hats or sunglasses. If you cannot do this feel free to send the additional applicant to Town Hall and we can take a photo of you.

First Name (Additional Applicant 2)

Surname (Additional Applicant 2)

Date of Birth (Additional Applicant 1)

Date of Birth (Additional Applicant 1)

Select Category (Additional Applicant 2)

Regular Pass

Senior (65+)

K-12 student (6-18)

Individual with disability

Upload Copy of ID (Additional Applicant 2)

Scan or take a photo of your ID (if over 18) and upload it here. If you cannot do this feel free to come by Town Hall and we will make a paper copy for you.

Upload Head-shot (Additional Applicant 2)

Take a photo of additional applicants head and shoulders and upload it here. Please take the photo against a white backdrop and remove any hats or sunglasses. If you cannot do this feel free to send the additional applicant to Town Hall and we can take a photo of you.

Payment

Please remember that your application will not be processed until you make $25 payment per applicant. Instructions on how to pay will appear once you submit this form.